- Ascension Health (Jacksonville, FL)
- …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... **Details** + **Department:** Case Management + **Schedule:** Part-time | Hybrid (frequently on...to physicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and… more
- Centene Corporation (Tallahassee, FL)
- …analysis, and/or ROI evaluation preferred. Familiarity with claims payment, utilization management , provider/vendor contracts, risk adjustment for government ... years of experience in healthcare analytics, large databases, data verification, data management , table creation and indexing, query optimization, utilization of… more
- HCA Healthcare (Sanford, FL)
- …with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party ... is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe Hospital is a 221-bed… more
- Elevance Health (Fort Lauderdale, FL)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as… more
- Evolent (Tallahassee, FL)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more
- HCA Healthcare (Gainesville, FL)
- …with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party ... is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed,… more
- HCA Healthcare (Brooksville, FL)
- …of experience in a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management required. + Knowledge ... and Qualifications** We are seeking a Director of Quality Management . As our Director, you will provide direction to...you will provide direction to ensure the facilitation and utilization of diverse strategies and communication for quality and… more
- ChenMed (Lauderhill, FL)
- …market leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management ... deemed necessary. Other responsibilities may include: Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible… more
- Evolent (Tallahassee, FL)
- …Description As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… more
- Molina Healthcare (Tampa, FL)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more